<form class="form-horizontal">
    <input type="hidden" id="id" value="">
    <div class="control-group">
        <label class="control-label" for="company_name">Nombre Compañia</label>
        <div class="controls">
            <input type="text" id="company_name" placeholder="Nombre Compañia">
        </div>
    </div>
    <div class="control-group">
        <label class="control-label" for="company_ruc">RUC</label>
        <div class="controls">
            <input type="text" id="company_ruc" placeholder="RUC">
        </div>
    </div>
    <div class="control-group">
        <label class="control-label" for="company_address">Dirección</label>
        <div class="controls">
            <input type="text" id="company_address" placeholder="Dirección">
        </div>
    </div>
    <div class="control-group">
        <label class="control-label" for="tax">IGV</label>
        <div class="controls">
            <input type="text" id="tax" placeholder="IGV">
        </div>
    </div>
    <div class="control-group">
        <label class="control-label" for="current_year">Año Actual</label>
        <div class="controls">
            <select id="current_year">
                <option value="2013">2013</option>
                <option value="2014">2014</option>
                <option value="2015">2015</option>
            </select>
        </div>
    </div>
    <div class="control-group">
        <label class="control-label" for="current_month">Mes Actual</label>
        <div class="controls">
            <select id="current_month">
                <option value="1">Enero</option>
                <option value="2">Febrero</option>
                <option value="3">Marzo</option>
                <option value="4">Abril</option>
                <option value="5">Mayo</option>
                <option value="6">Junio</option>
                <option value="7">Julio</option>
                <option value="8">Agosto</option>
                <option value="9">Septiembre</option>
                <option value="10">Octubre</option>
                <option value="11">Noviembre</option>
                <option value="12">Diciembre</option>                
            </select>
        </div>
    </div>
    <div class="control-group">
        <div class="controls">
            <button id="edit_action" class="btn btn-primary">Editar</button>
            <button id="cancel_action"  class="btn">Cancel</button>

        </div>
    </div>
</form>